I'm not sure how the Elavil works for pain, just know that it worked for me. I have had atypical trigeminal neuralgia since '97. At it's worst pain level, somewheres around 2002, I was on 3600mg of Neurontin/ day, plus 2000mg of Vicodin/ day!!! Still experiencing pain, making the run from this neuro to another, still another...trying to find one that was even the least bit familiar with treating TN. After having tried Tegretol, Trileptal, Topamax, Baclofen..just to name a few, none of which had helped with my pain, a new neuro. asked if I had tried Elavil AND neurontin. I explained that yes they had tried the Elavil long ago before starting the neurontin. He then said "No, no...I mean BOTH as a medicine cocktail!!" Needless to say, I was scared of what this guy was trying to do to the pain, but figured I had nothing to loose at that point.
To shorten the story, I was totally pain free within 48 hrs, was totally off of the Vicodin a month later. Three months after that I began weaning down from the Elavil and remained totally pain free with just the neurontin for 3 yrs there after!!! So for me....it's the miracle drug, even though people DO know it yes, as an anti depressant.

Marilyn